Category: Blog

2016 was one of the best years for great music in a long time. The variety of music and the genre-crossing movements made for a diverse and eclectic list of artists this year. Below is the list of my favorite albums of the year. I ranked these albums based on their holistic perspective. There were a number of great artists and songs in 2016 that may not have passed the ear test as a holistic album (or just released singles like my favorite song of the year “Wilderlove” by John Mark McMillan). So without further ado, here are Joel’s top albums of 2016.

Before getting into the top 10 it is worth noting the albums that did not make the top 10. In prior years, this list of honorable mentions would easily be my top 10 list. Macklemore is not everyone’s cup of tea but this album follows The Heist as a both light-hearted and deep record with a good beat. That is a very tough combination to find. St Paul and the Broken Bones’ Sea of Noise is a great album along the lines of Alabama Shakes and is one of the most soulful albums of the year. And what can you say about Radiohead? The never disappoint and while this album did not crack my top 10, it was still a fantastic album.

You’ll see a number of other great albums in this list from another solid Lacrae album to the unique R&B of Gallant.

Honorable Mention

Macklemore: This Unruly Mess I’ve Made

St Paul and the Broken Bones: Sea of Noise

Radiohead: A Moon Shaped Pool

Lacrae: Church Clothes v. 3

Young the Giant: Home of the Strange

Bastille: Wild World

ScHoolboy Q: Blank Face LP

Drake: Views

Francis and the Lights: Farewell, Starlite!

Gallant: Ology

Anderson .Paak: Malibu

Joel’s Top 10

Adam Young: The ScoreThis is actually a series of album by Adam Young more commonly known as Owl City. Young has released an album every month since February under various titles and themes. Each album is aptly named and is largely instrumental. While the music sounds more like the soundtrack to action or sci-fi movies, it does a wonderful job of combining orchestral sequences, piano and the occasional guitar. The output is fantastic music to listen to while relaxing in the sun or background music while trying at work. Apollo 11 (his first in the series) is probably my favorite but these have been on repeat in the background at work for months.

Chance the Rapper: Coloring Book vol 3This is a fantastic album and has topped many annual lists this season and rightfully so. Chance the Rapper has created a poignant album that is unique and powerful. Tackling difficult topics (Same Drugs) right alongside gospel songs (How Great) he adds piano, rock beats and a hip hop undertone with a combination of R&B and Hip Hop that is unique in the market. He breaks the typical approach of artists like Drake and even Kanye West to create an altogether new album that feels like nothing else. Partnering with others like Francis & the Lights (Summer Friends) and Future (Smoke Break) creates a different feel while keeping a common flow to the album. The reason I couldn’t put this album in my top 8 was while I appreciate and love many of the songs individually, Chance’s interest in foregoing the typical melodic approach to the album as a whole makes it less easy to listen to the album all in one seating. With that said, this album needs to be heard and what he is doing the industry sorely needed.

Gungor: One Wild Life: SpiritI have been a backer of Gungor for years. A band that started in the Christian worship industry but has gone through a number of twists and turns of deconstruction over the years and has now settled into a unique spiritual journey. They have released three albums over the last year under the title One Wild Life. The first album Soul from last year was one of my favorite albums of 2016. This year both Body and Spirit have been on rotation but Spirit with its more lively songs (Anthem) or the light hearted songs (Magic) they have created a consumable yet powerful album. Michael and Lisa Gungor address some difficult conversations (Let Bad Religion Die) and difficult times (Huricane) all while maintaining beautiful vocals. The mixture of stripped back songs that quickly turn to sonic walls of music make for a great album start to finish.

Needtobreathe: HARDLOVEUnquestionably my favorite album by Needtobreathe, this is a band I have followed for over a decade. I saw them at a festival back in 2006 when they were a relatively unknown southern rock Christian band. The depth and diversity to their music over the last several years is why they hit #2 on Billboard top albums this year. Their mainstream success is due to the wonderful lyrics and powerful vocals by Bear Rinehart along with his brother Bo. I have seen them now three times in concert over the last few years and they have never disappointed. They have wonderful energy on stage and can highlight the range on their album. From the eerily beginning to the album (Mountain, Pt. 1) to the pop inspired (Happiness) and the poignant love ballad (Clear), they have all of their bases covered. On this list, this is one album that I really skip or stop.

A Tribe Called Quest: We got it from Here… Thank You 4 Your ServiceThis could have gone horribly wrong. A band reunites for an album after 20 years and one the key members of the band dies. Those who have loved Hip Hop for a long time have held this group up to another level. What came out was a fantastic album that is at the same time a throwback to their earlier years and something completely new. It feels unique and certainly 2016. I dare anyone to listen to this album and not end up bobbing their head. When Phife Dawg passed in March (complications from diabetes), A Tribe Called Quest still released the album in August that included Phife’s talents. When a hip hop band can address large issues around democracy and race relations in the United States while adding in snippets from Willy Wonka, they deserve credit. This album is one that I can listen straight through and catch more and more of the fantastic raps and underlying beats.

NOTE: Explicit Lyrics

Jack Garratt: PhaseMan, what a debut! Jack Garratt from the UK released his first album this past February entitled Phase. While many of the singles were released in 2015, the album is a fantastic genre-defying experience. His smooth vocals on top of a strong beat and the occasional explosion of sound make for an album you can just as easily run to as work. This is an album that is better served listening to with a great pair of headphones. The crisp layered sound underneath his vocals differentiates him from others in the genre. The rock elements to the album are what draw me to Garratt compared to similar artists like Anderson .Paak and Gallant. While some albums, no matter how good, can wear on you, this one has yet to disappoint months later. Listening yet again for this list, I ended up listening through the entire album with my foot tapping. Fantastic debut and can’t wait for what Garratt brings next.

Bon Iver: 22, A MillionI like experimental. I like different. And for some Bon Iver is too much of both. But for me, his continuation of his experimental sound in this year’s 22, A Million strike a chord. This is another album that takes multiple listens to truly appreciate the layers of sonic goodness that Bon Iver brings. His tenor vocals are often looped and layered creating a unique sound in the industry. The last song off his album prior to 22, A Million entitled Beth/Rest has been my favorite of his songs since its release in 2011. This album is ultimately a full album in that vein. If I am looking for an introspective voice to sooth my soul, I can’t find any better that Bon Iver.

Leonard Cohen: You Want it DarkerWith sadness, this may be Leonard Cohen’s last album. When he passed this November, I was profoundly moved. I was a late follower of Cohen after hearing his inclusion in the Natural Born Killers soundtrack in 1994 and I was hooked. Along with Bob Dylan, Cohen has been a go-to for poignant lyrics. Very few can write songs like Dylan and Cohen. Add his deep vocals with simplified piano and guitar and you have created a sound that may never be matched. His latest album is unquestionably my favorite. While the album lays bare Cohen’s spiritual turmoil in a world he finds so dark that he’s ready to give up, there is hope laced with the cynicism to create a perspective we can all relate to. We cannot ignore the despair of this world so how do we live within that? Mr. Cohen, I will miss your contribution to music and thank you for leaving us with a fantastic album start to finish to honor your legacy.

Sho Baraka: The NarrativeSho Baraka’s album the Narrative is a commentary on the plight of the African American experience through the eyes of a fictional character named Louis Portier. He uses the sounds and experiences of black Americans through the years to tell his story. From the story of slaves to the civil rights movement to a perspective on what Kanye’s rants add to the discussion. So how does this album rank so high on the list compared to other Hip Hop artists like Chance the Rapper? No other albums take the narrative concept (no pun intended) to a whole new level. Integrating soul and hip hop beats seamlessly to create a sound that is unique yet approachable. Add lyrics that address issues that are challenging to all Americans, and it becomes an album I couldn’t stop listening to all year. Smooth is the best way to describe the sound. That makes The Narrative an experience that you can listen to over and over and find new beats and meaning each time.

Clout Cult: The SeekerI’m late the Cloud Cult bandwagon and for that I apologize. I get it. The experience that is Cloud Cult is more than a music thing. It is more than a live show thing. Cloud Cult knows who their followers are and what they crave. With that passion in mind, they create a community of listeners. The Seeker is quite possibly my favorite album in the last decade. It is a concept album that is intended to tell a story about those of us that are seeking. We’re not always sure what we are seeking but know that we are not satisfied just going through the motions of life. Craig Minowa and the collection of beautiful artists he has surrounded himself with create an indie rock sound that is difficult to categorize. Their combination of beautiful vocals and eerie sounds combined with some of the most beautiful orchestral moments ebb and flow throughout the album. Most of all though, is Minowa’s ability to capture life lessons in a way that is rich, deep and complicated but also simple to understand and grasp. This is the album I listen to when I am on a walk and want to experience God. Even if you don’t believe in a pure definition of God, it is difficult to listen to this album and not feel a calling to something greater than yourself. I’ll let this album speak for itself but if you choose to listen, plan to sit and breathe in this album. It is not one that lends itself to easy driving music or background music. As the first song proclaims “Oh, my love. Oh, my hope, the Great Mystery cannot be solved. There will be joy and grief, but live it all in awe.”

And that’s it folks. So what did I miss? Right albums but wrong order? Feel free to leave your comments below.

There is a common term in consulting that highlights there is a triangle relationship between resources, time and scope. If you want to decrease resources, you need to subsequently decrease either quality or scope. If you increase scope, you need to also increase resources to maintain quality. It is an age-old adage that also rings true with healthcare.

A recent article in Journal of the American Medical Associationhighlighted a similar triangle within healthcare that included access, cost and quality. The similar examples hold true. If you increase access to all, you must also increase cost which may adversely impact quality. If you want to increase quality, you probably will impact cost.

After reading the article several weeks ago, something didn’t seem right but some a simplistic example. We often recognized that new tools or processes within consulting/implementation could dramatically increase quality and overtime would be more cost effective with fewer resources.

As usual, I was not alone in the thinking and came across a compelling article by David Liu, MD. The article highlights that disruptive technologies and innovative solutions will transform the industry over time as it did for personal computers, air travel and many other industries.

The question that this all begs me is what will that solution be? As Dr. Liu points out, who will lead the charge? We have many different stakeholders in the industry and each has a perspective on what that solution should be and how to drive it. Who wins? For the point of discussion, let me throw out some of solutions that have been explored in recent years. I would be interested in hearing which of these is truly transformative and which are just ‘re-packaging’ the old.

Cash-carrying/bartering: Back to the days of Dr. James on main street doing house calls and being paid by a quarter cow. Will removing the bureacracy of insurance claims, payments, coding and other components, dramatically improve the industry? Will it not only be more cost effective but also increase the quality of care?

ACOs: Is moving the risk closer to those that manage the care truly going to revolutionalize the industry? Can it be implemented in a cost effective manner? Are there only certain organizations, regions, etc. that make these viable?

Health Benefit Exchanges: Are the regulations around these exchanges worthwhile and effective in driving down cost and expanding access? Will those efforts reduce the quality of care?

EDI/EHR Integration: Technologies that integrate clinical data could revolutionize the industry. But what if these systems do not holistically integrate? What if you ATM card only worked at your bank’s ATMs? How would that help with access? And does the cost reflect the improved quality gained by these innovations?

The convergence of the physician and payer organizations. Cutting out the middle men should reduce costs, right? And the integrated care should improve quality right? But what about access? And what if the integration creates a monopoly?

I am sure there are many other options. But if nothing else…food for thought.

As we within the Healthcare IT industry drive what needs to be tackled in 2011, there are numerous articles, reports and discussions around the top items to focus on in the coming year. I found one succinct article that does a nice job of articulating the top 6 items.

#1: Booming business in health information technology
#2: Gearing up to redefine health insurance: From MLRs to insurance exchanges
#3: ACOs: Is this the next big thing or not?
#4: Nowhere else to cost shift: Consumers could continue to reduce utilization
#5: M&A: Deals will bond the familiar and unfamiliar as organizations look to fill strategic gaps
#6: Follow-me healthcare: Patients look to health organizations that are always on

While I commend PwC for truly tackling the major items, I do think there is one underlying item that was missed. Truth in transparency. While healthcare consumers are dealing with the cost shift and while payers are working to establish the strongest network with the highest quality of physicians, much of this is down behind the scenes with little shared. Consumers need to be equipped with transparency in pricing. How quality is measured needs to be transparent and shared with the consumers. This will lead to a more educated consumer in how and where their dollars are spent in 2011.

I have the opportunity this week to join one my client’s at their user conference. It is amazing to hear direct feedback from the ultimate recipients of the work you have completed. It is equally interested in hearing where you may have missed the mark, where you hit the nail on the head and what their thoughts are on your next steps.

All too often organizations assume they know what members/clients/users want. Sometimes they are right and they are ahead of the curve. These visionaries are unique in the industry and differentiate themselves (Facebook’s News Feed, Google’s Instant Search, etc.). Others see where these stakeholders need and eventually will go but they are not quite ready to get there (Google Wave or Google Health among others).

The question becomes where is the sweet spot and how do we get there? This is a question many healthcare solution providers are pondering. My recommendation is you start not just by listening to your membership but witnessing their experience, documenting their struggles and seeing first hand what isn’t working for them. Start there and you’ll be headed in the right direction.

There was an interesting article written several months ago by Jeff Jarvis. Jeff is a commentator on a new podcast I began to follow called This Week In Google (TWIG). With the recent discussions around Net Neutrality, I worked back through some of his blog and found his proposed “Bill of Rights in Cyberspace.” Here is his description of what his attempt was:

This Bill of Rights attempts to establish the fundamental freedoms of our internet that must be protected against abridgment by governments, companies, institutions, criminals, subverters, or mobs. I suggest in my column that in its confrontation with China, Google is acting as the ambassador for the internet to the old world under its own (rediscovered) principles. So we would be wise to establish our principles. I ask the column’s readers to come to this post to suggest and discuss articles.

One of the most interesting points he raises is around who controls/owns your data. His assumption is it should be you but it raises questions around around access, copyright and portability. Interesting read.

These same consumers who – because of the downturn in the economy and subsequent job loss – are now shopping for, or considering shopping for, a new individual or family health plan might gravitate towards a PPO that features the lower deductibles they are both familiar and comfortable with from past experience as a member of a group health plan.

Interesting impact on the Consumer-Driven Health Care. What this makes clear is every solution has ramifications to patients, doctors and payers.

by Aldebra Schroll, MD

It has been three months since I closed the door on my primary care office for the last time. It was with a heavy heart that I said goodbye to the many patients I cared for over the last six years. I am the fourth physician to leave the practice in as many years.

One of the areas we hear over and over again in trying to solve our health care situation is transparency of cost for our consumers. This is a great illustration of the challenge.

Disservice (dĭs-sûr’vĭs)

A harmful action; an injury

An act that is not just

Our health care system is completely devoid of customer service. It is pathetic.

I took my son to have a simple tympanostomy (ear tubes) procedure this morning. I show up, sign in and take my seat amidsts the throngs of people in the surgical center waiting room. I brought my laptop and some reading materials to bunker down for the long wait ahead.

20 minutes later I get called up front to sign some additional paperwork. Instead of being greeted, 15 documents each complete with a full page of legalese is shoved my way regarding various aspects of responsibility, payment, agreement, arbitration, and host of other information. The grumpy lady has clearly done this a thousand times and she has absolutely no tolerance for any of my questions. She paries my first few skillfully, but I don’t let her blunt my questions regarding the finances.

She shows me that the facility is charging me $5,600 but that fee has been reduced by the insurance to $1,799. This is an all in fee for the facility only (includes staff, equipment, monitoring, etc) and does not include fees charged by the physician and the anesthesiologist. I ask what those charges will be (I already knew ahead of time), but she says she is not responsible for their charges and that I would have to speak with those providers about that. I start asking her why they don’t bundle everything into one price so I can compare across various combinations of facilities and providers. She has no idea what I am talking about and ends the conversation by giving me their phone numbers. Take your seat Mister, how dare you ask a question about pricing comes across clearly as she stares me down to my seat.

I immediately pick up the phone and talk to the physician office. After about 10 minutes, I finally get the billing person who is able to provide me the CPT code (69436) and Zip Code (92691) as well as what they charge for procedure ($345). I tell here I am not interested in her price because it is irrelevant and that Blue Cross has already dictated the price that you are going to get. A little defensive, she then relays to me the the administratively set Blue Cross reimbursement that has been dictated to this particular physician ($208.08). I then ask her about bundling of services and created an Ear Tube product that would include all the components so that I can compare across facilities and providers. She has no idea what I am talking about. I give her the hamburger example (I don’t get separate receipts for tomoatoes, buns, and burger – I get a single price for the thing I want – the complete hamburger). I refer her to Carol.com as an example and she thinks this sounds like a good idea. When I ask why they don’t do it now that she understands, she says that she doesn’t think the physicians would ever agree to work in that way. She tells me she will pass this along to the physicians, and with a laugh that indicates that will never happen, we end the call.

Next, I call the anesthesiologist group. First the lady attempts to tell me she can’t give the pricing because it is a HIPAA violation. I quickly disabuse her of her ignorance and get her manager on the phone. Anesthesia is unique in all of medicine because anesthesiologist charge for their time in increments called units (typically 15 minutes). So they get a “set up” fee and a “time-based” fee for their services, both in terms of units. So I ask them what their per unit charge is and the manager tells me that it is proprietary information. I call him out on it and say that pricing information is not proprietary, perhaps his costs structure is, but he has a duty to tell me the cost of the service I am about to engage him in. I am pretty frothy at this point and really lay into this guy. He still refuses to tell me his proprietary, negotiated per unit rate with Blue Cross but relents on giving me the overall price. He then passes me along to someone else who looks up in their database and tells me the cost will be either $300 or $360 for the procedure for either a 15 minute or 30 minute anesthesia time. So, knowing they go in 15 minute unit increments, I can tell that there is either 5 or 6 units involved, and therefore a $60 / unit price. So, full pricing is 4 units “setup” and either 1 or 2 units for their time. So much for your proprietary formula and negotiated pricing. $60 bucks every 15 minutes or $240/hour for anesthesiologist time. Thats mid-tier lawyer rates for South Orange County but interesting in how at least this type of physician’s time might be valued by insurance companies.

So finally, after about 45 minutes of phone time, by someone who knows the ins and outs, all the secret handshakes and covert codes, and most aspects of healthcare financing, I am able to arrive at an all in price for a very simple surgical procedures:

This is great to know the price information for my selected combination of facility and physicians. However, I have no information on outcomes achieved, safety rates, customer satisfaction, or other metrics to determine if I would not be better off with a different combination of facilities and physicians. What do you think the response was when I attempted to ask about health outcomes for my physician?

Pin drop, anyone?

This is not just another rant, but meant to highlight that the very basic, fundamental courtesies expected during a consumer transaction are all but non-existent in health care. Simple things like getting pricing information, like getting helpful customer service, like understanding what you are buying, and the quality features that attract you to purchase something in the first place. Health care should be one area where customer service is impeccable. I believe you begin to see “brands” emerge that get this, invest in it, and deliver it consistently over time. Looking forward to the ongoing retailization of health care – it truly needs it.

Want to know how to radically change the health care industry? This guy gets it.

Over the past 5 years, I worked with HITSP and the HIT Standards Committee to select standards for exchanging clinical summaries. But what exactly is a clinical summary?

There is common agreement about the need to exchange codified, structured data for problem lists, medications, allergies, and labs.

However, what is the role of unstructured clinical documentation text?

Some have suggested that unstructured text is hard to navigate, at times repetitious, and challenging for computers to interpret.

I believe the exchange of free text notes such as operative reports, history&physicals, ED charts, consult notes, and discharge summaries is very important.

Consider this example.

A 40 year male with no family history of heart disease presents to the ED at 3am with a chief complaint of chest pain and left arm numbness. The EKG is normal, a stress test is normal, labs are normal, and a cardiology consult is completed. The patient is discharged on H2 blockers with a diagnosis of gastritis.

A summary which only includes a problem and med list may state a Problem List of Gastritis and a Medication List of Prilosec OTC.

When the patient next visits an Emergency Department, no one will know about the cardiology consult, the differential diagnosis considered, and the thought process that led to the diagnosis of gastritis to explain the chest pain.

“Free-text narrative will often be superior to point-and-click boilerplate in accurately capturing a patient’s history and making assessments, and notes should be designed to include discussion of uncertainties.”

I agree.

Notes should be included as part of clinical summaries.

However, we should do all we can to improve the quality of notes.

Over the next year, we hope to try a radically different approach to clinical documentation at BIDMC which we think will leverage all the strengths of the full text note as described by Drs. Schiff and Bates without the repetition and navigation issues.

Today’s inpatient charges are a collection of SOAP notes written by the medical student, intern, resident, fellow, attending, and consultants largely for billing and medico-legal purposes.

What if the chart was recast as a communication vehicle for the entire team that summarized the day’s events and collective wisdom on next steps?

Our answer – a daily Wiki entry for each patient authored by the entire team and signed/locked by the attending at the end of each day.

How will this work?

Think of it as a private wikipedia build inside our clinical systems and hosted in our data center.

Each member of the care team will use our Team Census application to view the list of patients for whom the team is responsible.

Clicking on any patient name will bring up the daily Wiki. Each member can add documentation, revise existing text, and leverage the work of others on the team until the attending makes the final edits and signs/locks the day’s documentation. Just like a wiki, a complete journal shows all all edits/changes/deletes, so no information is lost. Importantly the day’s wiki entry has one physical exam, one assessment, and one plan – not 17 repetitive entries saying the same thing that often appears in today’s paper charts.

The idea of a daily wiki entry for each patient creates highly readable succinct documentation authored by the entire team with a medical legal record of the process that was used to generate it. It’s a perfect single document to share with the referring clinician and the patient/patient’s family.

After our initial pilot work, I’m guessing we’ll also engage the patient and families to add to the Wiki, reflecting the shared decision making between the team, the patient, and the patient’s family.

We’re in the design stage now, but I’ll report back on how it goes.

A daily patient Wiki as unified clinical documentation, exchanged with the team, other providers, and the patient. I bet even the free-text naysayers will agree that this should be part of the clinical summary!

Some were wondering on ways to leverage the iPad beyond the super consumer. Here is an example of use at Providers.

The following is a guest post from Dr. Larry Nathanson MD, who leads BIDMC’s Emergency Medicine Informatics efforts. (Note that the photo contains only fictitious patient names):

I had been anxiously awaiting the arrival of my iPad –This is the form factor I have been asking (begging) of all the vendors for years. I’m very happy to say that it appears to be living up to my high expectations.

The screen is gorgeous. It’s very clear and bright, I had no trouble seeing the screen in bright outdoor light. The machine seems extremely responsive — it reacts immediately to user input and the browser renders pages as fast as my laptop. In landscape mode, its surprisingly easy to type on the on screen keyboard. I wouldn’t call it “touch typing” but the autocorrection fixes almost all of the typos that are introduced when I just let my fingers fly. It turns out to be much easier to enter data than I expected, and in fact this entire review was typed completely on my iPad.

I tested it today during my shift in the ER. Initial tests with our clinical applications went amazingly well. The ED dashboard, WebOMR and Provider Order Entry all appear to function well without modification. The popup blocker does try to get in the way of new windows, but it’s a only a minor annoyance. The EKGs look better onscreen than on paper. It was great having all of the clinical information right at the bedside to discuss with the patient. The only problem was that the increase in efficiency was offset by the patients and family who wanted to gawk at it.

The battery life is one of the most astounding features. I don’t know how they did it but the claimed 10 hour run time might actually be more accurate than the usual inflated claims that I’m used to for mobile devices. The device arrived at full charge and after testing all day and leaving it playing several full length movies the battery still had 40% left. This could easily make it through an entire ER shift on one charge, eliminating the need for hot swappable batteries.

I am a little concerned about how well it will hold up in a clinical environment, particularly the abuse it will get in the ER. The case is very smooth and the rounded bottom makes it easy for it to slide out of a hand or off a table. I don’t get the feeling it will be as forgiving of drops as some better padded (albeit heavier) devices. I’m hoping someone will create a case that has a hand strap on the back (like the Panasonic MCA has).

One problem that plagues all tablets that I’ve used clinically is the difficulty entering strong passwords. The onscreen keyboards of mobile devices makes it much harder to quickly enter numbers, symbols and mixed case and is, in my opinion, one of the biggest barriers to medical tablet adoption. A biometric, or other creative way of addressing this will likely be needed.

From a consumer electronics point of view I’m also impressed. When just web surfing or watching video I do like that I can just lean back and hold the iPad as I would a book or magazine. My wife found that she preferred the iPad Kindle program to the actual Kindle device. (That bodes poorly for my plans to develop software on it!)

In summary, I’m very excited — the form factor is close to perfect and it’s robust enough to keep up with a busy ER. I think this is one of the most promising developments in medical mobile computing in a long time.

There is one major drawback however: Now my iPhone seems slow and inadequate!